Provider Demographics
NPI:1780734384
Name:AIELLO, ANGELO J (OD)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:J
Last Name:AIELLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3227
Mailing Address - Country:US
Mailing Address - Phone:856-231-7719
Mailing Address - Fax:
Practice Address - Street 1:689 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3227
Practice Address - Country:US
Practice Address - Phone:856-905-9852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ3940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1126806Medicaid
NJ521447C0ZOtherMEDICARE
NJ681618Medicare PIN
NJ681618OtherMEDICARE ID